AB0438 TAPERING BIOLOGICAL DMARD IN RHEUMATOID ARTHRITIS: REAL-WORLD EVIDENCE.
Authors: W. G. Rojas Zuleta, M. Barbosa, C. Becerra-Arias, O. J. Felipe Díaz, J. H. Donado Gómez, L. A. González, N. Duque Zapata
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> biological DMARDs have revolutionized the treatment of rheumatoid arthritis (RA), demonstrating effectiveness in terms of symptom control, improvement in quality of life and radiographic progression. However, their high-cost impacts global health systems. Therefore, tapering strategies are important therapeutic strategies to consider in patients with sustained remission. It is estimated that up to 50% of patients with bDMARDs and sustained response would be successful upon biologic therapy optimization [1]. <h3>Objectives</h3> to estimate the relapse rate in patients with RA on tapering bDMARD protocol. <h3>Methods</h3> This is an observational cohort study of established RA patients followed in Medicarte, a Colombian specialized outpatient clinic, between 2014 and 2022. Selection criteria included patients ≥18 years of age, with a diagnosis of RA according to the 2010 EULAR classification criteria, who has been in remission for at least 12 months and agreed to enter the bDMARD reduction strategy either by reducing the dose or increasing the interval between doses. Relapse was defined according to the consensus of the Spanish Society of Rheumatology: mild relapse as an increase in DAS28&gt;0.6 and final DAS28 &gt;3.2, and severe relapse as an increase in DAS28 &gt;1.2 [2]. Quantitative variables are presented as medians (interquartile range, IQR), while the qualitative variables as frequencies (percentages). Kaplan Meier was used to estimate the survival drug, according to tapering medication strategy and incidence density. A <i>p</i> value &lt;0.05 was considered statistically significant. <h3>Results</h3> 167 patients [82.6% women, median (IQR) age of 59 years (52-65), and median (IQR) disease duration of 13.7 years (7.7-20.8)] were included. They have been in the tapering strategy for 2.4 years (IQR: 2-3.7). The median (IQR) of DAS 28 -CRP before start of tapering was 1.2 (0–1.6) and at the end of follow-up was 2.12 (IQR 1.54–2.77). Increasing the interval between doses was used as a tapering strategy in 70.1% of the patients. The most frequently bDMARD used was etanercept [n=57 (34.1%)], followed by tocilizumab 27.5% [n=46, subcutaneous and intravenous (27.5%)], adalimumab [n=27 (16.2%)], abatacept 8.4% [n=14, subcutaneous and intravenous (8.4%)], certolizumab 4.2% [n=7 (4.2%)], subcutaneous golimumab [n=11 (6.6%)], rituximab [(n=4 (2.4%)], and Infliximab [n=1 (0.6%)]. Relapses were observed in 24 (14.4%) patients while on biologic therapy optimization, being more frequent with certolizumab and abatacept. The lowest rates of relapse were observed with infliximab, adalimumab and etanercept, while certolizumab and abatacept had the shorter time to relapse (table 1). Overall, the relapse rate was 5.5 per 100 patient-years with RA at risk (p=0.021) (figure 1). <h3>Conclusion</h3> Tapering bDMARD strategy was effective in our large RA cohort with 85.6% of patients remaining in remission during the follow up. Adalimumab, etanercept and tocilizumab were the bDMARDs with the longest time to relapse. These findings support the use of the tapering strategy in patients with established RA. <h3>References</h3> [1]Cárdenas MJ, de la Fuente S, Castro-Villegas MC, et al. Optimization of biological therapy in rheumatoid arthritis patients: outcomes from the CREATE registry after 2 years of follow-up. Rheumatol Int. 2017;37(10):1701-1708. [2]González-Álvaro I, Martínez-Fernández C, Dorantes-Calderón B, et al; Spanish Rheumatology Society and Hospital Pharmacy Society Consensus on recommendations for biologics optimization in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Rheumatology (Oxford). 2015;54 (7):1200-9. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Wilmer Gerardo Rojas Zuleta Speakers bureau: Pfizer, Jannsen Cilag, Bristol Myers Squibb, Biopas, Amgen, Eli lilly, Mario Barbosa: None declared, Carolina Becerra-Arias: None declared, Oscar Jair Felipe Díaz Speakers bureau: Pfizer, Jannsen Cilag, Bristol Myers Squibb, Eli lilly, Jorge Hernando Donado Gómez: None declared, Luis Alonso González Speakers bureau: Pfizer, Jannsen Cilag, Bristol Myers Squibb, Natalia Duque Zapata: None declared.